Pathways To Primary Care: Charting Trajectories From Medical School Graduation Through Specialty Training

Shortages of primary care physicians threaten access, quality, and equity in US health care. Policy solutions face disinformation about the complex patterns of physician training. This retrospective cohort study used American Medical Association Physician Masterfile and Historical Residency File data to identify physicians' trajectories from medical school graduation through postgraduate training into primary care specialties for doctors of medicine, doctors of osteopathic medicine, and international medical graduates. Sankey diagrams illustrate flows through training programs. Among 353,590 physicians who graduated during the period 2001-15, 11.8 percent pursued initial training in family medicine, 33.5 percent training in internal medicine, and 10.5 percent training in pediatrics. Primary care yield, defined as the percentage of physicians who complete their initial postgraduate training in a primary care specialty and conclude their training in any primary care specialty, was 97.0 percent for family medicine, 35.5 percent for internal medicine, and 54.4 percent for pediatrics. After internal medicine and pediatrics residencies, large percentages of physicians left primary care to train in subspecialties and other fields. Further research must document how many physicians enter careers in primary care practice.